Category Archives: binge eating disorder

The National Eating Disorders Association (NEDA) in conjunction with the Congressional Mental Health Caucus hosted a Congressional Briefing on Capitol Hill on October 2, 2018. This briefing was held to educate representatives and legislative aides about eating disorders in overlooked populations. Panelists at the briefing included Chevese Turner (moderator), Mike Marjama, Claire Mysko, Janell Mensinger, PhD, and Steven Crawford, M.D.

Dr.Crawford, co-director at The Center fo Eating Disorders at Sheppard Pratt, began by discussing the different eating disorders and the risks and causes associated with them. He explained the differences in each disorder and the ways someone can help if they notice symptoms of an eating disorder in someone they care about. These include, seeking more information on the subject, locating resources, not focusing on weight, and encouraging the person to seek specialized treatment.

Dr. Janell Mensinger, an Associate Research Professor at Dornsife School of Public Health at Drexel University, presented on eating disorders and population weight. Her presentation focused on people in higher weight bodies and she explained how weight-related harassment is over four times more common than bullying. She stressed that we, as a society, need to shift focus from weight to health and provided research that shows eating disorders and extreme dieting are increasing among people in higher weight bodies.

The next panelist Claire Mysko, CEO of NEDA, spoke about a prevention program called the Body Project. The Body Project is a group-based intervention that helps decrease eating disorder symptoms and body dissatisfaction in high school girls. There are currently 388 trained facilitators for this program across the United States. Mysko also mentioned how NEDA is working on a similar program for young men.

The final panelist was former Seattle Mariners Catcher Mike Marjama who now serves as a NEDA Ambassador. Marjama presented his personal struggle with body dissatisfaction and an intense desire to change his body, which led to extreme behaviors around food and exercise, an eating disorder diagnosis and eventually hospitalization. His treatment and recovery however, led him to a baseball career and renewed appreciation for mindfulness and balance. After retiring he decided to speak openly about his disorder and his story has since been featured on Good Morning America. As an Ambassador for NEDA his goal is to help boys and men see through outdated stereotypes about eating disorders so they can get the help they need.

Eating disorders are one of the most dangerous mental health issues and should not be taken lightly. Unfortunately, they are too often overlooked in people with higher weight bodies, in athletes of all calibers and in traditionally marginalized populations. Our hope is that the information shared in the Oct 2nd hearing will assist legislators in creating policies that not only support prevention and treatment for eating disorders but improve overall public health.

Additional Advocacy Resources:

Get involved, learn about state-specific legislative actions and become a NEDA advocate.

Read summaries of current legislative actions, read about current initiatives and get involved with advocacy days on Capitol Hill with the Eating Disorder Coalition.

You can find out more about The Center for Eating Disorders’ recent advocacy work here.

Every June, Pride month provides an opportunity to share awareness, knowledge and recognition of important issues facing the LGBTQ+ community. It’s a time to celebrate progress while recommitting to challenges that lie ahead. One such challenge among the LGBTQ+ community too often stays hidden: eating disorders.

While eating disorders may happen to anyone, current research suggests that those in the LGBTQ+ community may be at higher risk,1 beginning as early as age twelve.2 In a study of over 35,000 students, gay males were 28 percent more likely to report poor body image, 25 percent more likey to engage in binge eating, and 9 percent more likely to diet frequently compared to heterosexual males.3 What’s important to highlight is how outside influences can act as a trigger for these unhealthy and dangerous behaviors in marginalized populations. For example, daily discrimination among lesbians is associated with increased binge eating.4

Let’s take a closer look at stressors that may be unique to the LGBTQ+ community, including those listed by NEDA (The National Eating Disorders Association)5 and others identified by our patients and therapists.

Unique Stressors Faced by LGBT+ Individuals

Fear of rejection after coming out to one’s friends, family, classmates, co-workers and the public

Bullying, violence or threats at school, work or online, in some cases resulting in Post Traumatic Stress Disorder (PTSD)

Discrimination based on gender identity or sexual orientation

Hardship or stress related to identification with a gender that is different than the one assigned at birth

Internalized stigma where one begins to believe, internalize and/or act upon negative messages about oneself

Homelessness or unsafe homes occur among the LGBTQ+ population, with 42 percent of homeless youth identifying as such6

Unrealistic Body ideals within LGBTQ+ peers/community

Double minority status wherein one person experiences oppression as a member of more than one minority group (i.e. related to orientation, gender, religion, race or otherwise).

The Transgender Community

Specifically among transgender youth, a 2017 study reported that as many as one in four youths report engaging in at least one disordered eating behavior, with 35 to 45 percent engaging in binge eating or fasting. Experiences of discrimination, harassment, and violence – or enacted stigma – were often linked to greater levels of eating disorder behaviors among trans youth.7

This same study also indicated that there are some protective factors that help buffer enacted stigma from influencing eating habits in trans youth. Social support from family, friends and peers was associated with a lower percentage of trans youth engaging in binge eating. In other words, when family and school connectedness are present in the youth’s life the likelihood of binge eating decreases. In particular, the presence of family support drove the lowest probability of disordered eating.

Showing Support to the LGBTQ+ Community – 8 Ways to Help

Everyone can do their part to help lower risk factors associated with eating disorders in the LGBTQ+ community. The common thread is championing less violence and discrimination and more support and acceptance. Here are eight way you can help:

Know the signs and symptoms of disordered eating and be able to recognize them in a friend, family or peer. Watch this video for an example of how everyday conversations can be a chance to check in and offer support.

Be a listening ear to your LGBTQ+ friends, family and peers and be someone who they can talk to when they are upset or distressed

Respect identity by using preferred gender pronouns (i.e., he/she/they), name, and other terms – when in doubt, use neutral words (i.e., they, partner) or ask about preference

Ask early and specifically about the presence of eating disorder symptoms if you are a health or mental health provider working with LGBTQ+ youth. Early intervention leads to more positive recovery outcomes but many people don’t disclose disordered eating behaviors unless explicitly asked about them.

Start an LGBTQ+ club at your school or workplace to demonstrate your support and to help spread awareness

Educate yourself on the relationship between stigma, discrimination and eating disorders and help spread the word about common myths and facts

Remember the power of family connectedness as a protective factor.Create a welcoming home for your family members of all genders and orientations.

If you are a member of the LGBTQ+ community and you think that you may have disordered eating, or just want a judgement-free space to talk, call any of the following hotlines or visit https://www.eatingdisorder.org/letscheckin to take a free online self-assessment and get connected with treatment.

LGBTQ+ and Related Hotline Numbers

National Eating Disorder Hotline 1-800-931-2237

LGBT National Youth Talkline 1-800-246-PRIDE (7743)

LGBT National Hotline 1-888-843-4564

Sage LGBT Elder Hotline 1-888-234-SAGE (7243)

The Trevor Project (24/7) 1-866-488-7386

TrevorText (M-F 3pm-10pm) Text “Tevor” to 1-202-304-1200

The National Runaway Safeline 1-800-RUNAWAY (800-786-2929)

The True Colors Fund (homelessness) 1-212-461-4401

For more information about eating disorders and treatment options in Baltimore, visit eatingdisorder.org or call (410) 938-5252 for a free phone assessment.

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Whether we like it or not, grocery shopping is a necessary task of adulthood. It can be annoying or simply unenjoyable for anyone who is living a busy life or just doesn’t enjoy shopping or cooking. Most adults however, make it in and out of the grocery store regularly without significant disruption, problems or stress. But for the millions of individuals living with an eating disorder, an everyday task like buying food for themselves or their families feels completely overwhelming. Just thinking about going food shopping can trigger intense anxiety and may result in avoidance or elevated eating disorder symptoms. Actually going to the store and getting out before the milk gets warm seems impossible at times.

Since having consistent, structured and fulfilling meals are such a fundamental part of eating disorder recovery, being able to source and purchase the food for those meals then becomes a primary part of treatment. If someone is too anxious to step foot in the store, obsesses over the label on every item or finds they just wander aimlessly, it can really inhibit their ability to bring home the foods they need to meet their nutritional goals. As a result, difficulties with grocery shopping can become a significant barrier to recovery. That’s why our Outpatient Nutritional Coordinator put together these tips to help individuals with eating disorders (or anyone really) navigate the grocery experience and become more confident in your shopping ability.

Plan, Plan, Plan: This is one of the most impactful tips! Planning your meals ahead saves you time and money. It can also decrease anxiety at meal times since you know that you have something in place and what to expect. In order to maintain stable meals, you must have a menu planned and food available to meet that plan; remember to incorporate foods from all food groups. Set aside one hour, one day a week for meal planning. Planning ahead also cuts down on the amount of trips to the store you need to take during the week. One to two trips to the grocery store per week is reasonable

Organize your list: Based on your planned menu, create a grocery list. Breaking it down into the sections of the grocery store can cut down on time spent in the store. People that “wing it” end up wandering too long or revisiting the same aisle two or three times. Keep a pad of paper in your kitchen or a list on your phone where you can write down food staples that you run out of during the week; add them to your main grocery list before you go.

Be realistic: Set realistic expectations when you plan your meals. What do you have going on this week? Which nights will you have more time to cook? Which nights do you need something easy to assemble?At which meals would it make sense to use leftovers? Pick up a variety of foods that require different levels of preparation.

Mission possible: Set a time limit and stick to it. Make it your mission to be at the register in 30 minutes or less.

Add support: Go with a friend or support person for the first few times. Whether they know you have an eating disorder or not, this will help distract from any eating disorder thoughts in your head and will keep you more on task. Letting your support person know your goal of being at the register in 30 minutes or less can also help hold you accountable to not wasting time wandering aisles or compulsively comparing items.

Stick with what you pick: If you find yourself spending too much time reading labels or comparing similar products, try to make the decision based on which one is on sale that week. Choosing the item based on price can also help expose you to different brands and allows you to discover which one your taste buds truly prefer. Another way to decrease label reading is to view the grocery store ad online before going to the store when making your list. This allows you to view items without being able to read their labels and to commit to having them on your grocery list based on what is on sale. This is helpful for reducing time comparing products, getting exposure to trying different products out, and can save you money!

Shrink the store: Sometimes it’s fun to shop at a large grocery store and to have a lot of options, but for some people more options = more anxiety. If that’s the boat you’re in, try shopping at a smaller store such as Aldi, Eddie’s, or the grocery section at Target. It’s a lot easier to decide which yogurt to buy when you have three options instead of thirty! Having less options of yogurt, cereal, bread, crackers, etc, can reduce time spent in the aisles and will help you get out of the store faster.
Ditch the diet products: Avoid being lured into fat free, sugar free, “diet products.” They do not satisfy and will only leave you feeling hungry and stuck in the “diet mentality.” Normalized eating incorporates regular products that are more satisfying and enjoyable.

Avoid the crowds: Try to shop at times when the grocery store is not as busy. Typically during the week, 3-6pm tends to be the busiest time at the grocery store. Sundays are also very busy days. Try to go in the morning, later in the evening, or on Saturday. You can also look your grocery store up on google maps and look at their “popular times” bar graph to see less busy times to shop.
Check your status: Be mindful of your vulnerability factors. Are you tired? Stressed? Hungry? If the answer is yes, plan on engaging in some self-care first and going to the grocery store when you are feeling more rested, stable and satiated.

Ask an RD: If you need help planning meals, making grocery lists, expanding variety, and setting goals for improving your confidence with grocery shopping, ask your dietitian for support. If you do not have a dietitian, consider adding one to your treatment team if you are working through an eating disorder.

Remember that with learning any new skill, it takes practice and time. If you have negative experiences with grocery shopping in your past, try some of these tips to begin developing more positive associations with going to the grocery store. Over time, this will help decrease your anxiety around grocery shopping. Plus, having food available for meals will help you stay on track on your journey to recovery.

The Center for Eating Disorders is excited to announce the launch of a brand new Grocery Shopping Support Program designed to aid individuals working on recovery from eating disorders including anorexia, bulimia and binge eating disorder. Parents/Caregivers of children and adolescents are also eligible for participation. Program components and goals include:

Snack/meal/menu planning

Grocery list development

Incorporation of challenging foods

Efficiently utilizing time spent in stores

Managing impulsive food purchases

Identifying triggers and coping skills

Decreasing anxiety around food and food purchases

Exposure to food-based environment

Individualized treatment goals

If you’re interested in scheduling a grocery support appointment, please call (410) 938-5252. If you have questions about the program you can also email Hannah Huguenin.

Written By:Hannah Huguenin MS, RD, LDN
Outpatient Nutrition CoordinatorHannah has been an integral part of The Center for Eating Disorders’ staff since 2008, and provides individual nutritional counseling for the outpatient population. In her role at The Center, she manages the outpatient nutrition team and leads program development. She was instrumental in building the Center’s new Grocery Shopping Support Program. Hannah also provides ongoing support to help patients decrease eating disorder behaviors, meet their nutritional goals and improve their relationship with food through nutrition education.

JUNE 2014 – The Center for Eating Disorders has launched several new outpatient therapy groups in addition to our other longstanding groups for individuals with eating disorders. Group therapy can be a great way to obtain additional support in the recovery process while also mastering beneficial new skill sets and practicing social interactions in a therapeutic setting with the guidance of a licensed therapist. We invite you to review the current group therapy opportunities below and contact the group leader if interested.

THERAPY Groups…

Cognitive Behavioral Therapy (CBT) Group for BODY IMAGETuesdays, 5:15 – 6:15 PM
Participants can expect to learn about how to promote positive body image using the cognitive-behavioral model. The group lasts 10 sessions and will consist of a variety of body image topics (e.g. body checking, body avoidance, body comparison, emotional labeling, eating disorder mindset) and incorporates specific CBT skills with the goal of decreasing an individual’s preoccupation with weight and shape and their control. Please contact Laura Sproch, Ph.D. at 410-427-3851 for further information and to complete a brief phone screening.

Cognitive Behavioral Therapy (CBT) for ADULTSTuesdays, 5:15-6:15 PMThursdays, 6:15-7:15 PM
Participants in this group will learn about the cognitive-behavioral model and its application for eating disorders and for the individual. Group topics will rotate, based on the needs of the group, with a strong focus on the behavioral skills and making behavioral changes outside of the group. Skills include, but are not limited to, self-monitoring, imagery, deep breathing, behavioral chain analysis, body image behavioral skills and problem solving. Contact Laura Sproch, PhD at (410) 427-3851 for more information.

Cognitive Behavioral Therapy (CBT) for ADOLESCENTS in TransitionTuesdays, 5:30-7:00 PM
This is a Cogntitive Behavioral Therapy group for adolescents who are transitioning from a higher level of care (at any inpatient, residential or partial hospital eating disorder program) back into outpatient therapy. The groups runs on a six-week session. Contact Lisa McCathran, LCPC at (410) 427-3873 for more information.

Dialectical Behavior Therapy (DBT) Group Thursdays, 5:30-6:30 PM
DBT is an evidence-based treatment composed of four modules: Mindfulness, Distress Tolerance, Emotion Regulation and Interpersonal Effectiveness. Extensive research has found DBT to be beneficial in the treatment of a variety of disorders, including mood disorders, anxiety disorders, substance abuse and eating disorders. This particular DBT group is open to adults, ages 18 and over, with or without an eating disorder. Interested individuals, or referring providers, should call Craig Boas, LCSW-C at (410) 427-3879 to complete the screening process. You can read more about DBT and each of the four modules here.

Interpersonal Therapy Group for Adults with Eating DisordersWednesdays, 5:30-7:00 PM
A process-oriented group for adults (ages 22 and over) with any type of eating disorder. This is a thematic, open-ended group in which members are encouraged to process current and past struggles in a way that improves insight into the role of the eating disorder in their life and provides an opportunity to develop strategies for moving toward recovery. A variety of skillsets are introduced and practiced within the supportive framework of the group. Contact David Roth, PhD at (410) 427-3871 for additional information.

Motivation to Change Therapy Group Saturdays, 4:00-5:00 PM
Motivation to Change (MTC) is a group for individuals 18 and over with an eating disorder. Participants will be asked to complete a full module from beginning to end (12 groups per module). At the beginning of each module, participants will assess their stage of change and should be able to identify next steps and tools for implementing change by the end of each module. Please contact Rachel Hendricks, LCSW-C at 410-427-3862 for further information and to complete a brief screening over the phone.

SUPPORT Groups…

Collaborative Care Workshops for Caregivers & Family Members
(Now being offered completely FREE OF CHARGE to all interested families)Tuesdays, 5:30-7:00 PM
These 6-week sessions based on the work of Dr. Janet Treasure, are designed to address the most universal needs of the carers: connection with other carers; support; and skills training. Key skills taught include motivational interviewing, communication, the trans-theoretical model of change, self-care and behavior analysis. Research suggests that participation in these workshops, leads to benefits for both the carers and the patient. The workshops are OPEN to all support people at any stage of a loved one’s illness or recovery and are now being offered completely free of charge. You can read more about collaborative care on our blog. Call (410) 427-3874 or email Dr. Jennifer Moran to register for the group.

Recovery-Focused Community Eating Disorder Support GroupWednesdays, 7:00-8:30 PMRead more about this and other opportunities on our support group page.

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The Center participates with an extensive list of insurance providers which means group therapy services can often be billed through insurance or participants may choose to self-pay. If you are interested in joining any of the groups listed above, please contact the specific group therapist directly or call the main number, (410) 938-5252.

If you are a physician or therapist interested in referring a patient for group therapy as an adjunt to existing individual or family therapy, please feel free to call the contacts listed above. Our group therapists are committed to communication with providers in the community and to working collaboratively as a team to meet the needs of each patient. With the proper release forms, group therapists welcome ongoing communication, can discuss skills and principles being covered in the groups, opportunities to apply the skills to individual therapy, and other relevant goals and progress.

Does the idea of darkness during your 5pm commute home from work get you down? You’re not alone if you’ve noticed that it’s not just the flowers in your garden but also your mood that has “wilted” with the cooler temperatures. During the fall and winter months, people may experience a shift in their mood as we collectively adjust to less sunshine and more cold weather. But it might be more than just “the blues” if it is a persistent sadness that feels present most days and is interfering with your ability to function or engage in day-to-day life. If this is a pattern that’s occurred for at least two years in a row and impacts you at the same time each year, it might be Seasonal Affective Disorder.

Seasonal Affective Disorder (SAD)
Many people around the world suffer from SAD, now identified in the DSM-5 as Depressive Disorder with seasonal pattern. It is suspected that seasonal depression is, in part, caused by a reduced exposure to sunlight resulting in disruption to our natural circadian rhythm (the body’s “internal clock”), as well decreased levels of the hormones serotonin and melatonin which help to regulate mood, sleep and appetite. Not surprisingly, populations living farther from the equator experience higher rates of seasonal depression than places closest to it. Thus, this type of depression occurs more frequently in populations throughout the northern rather than southern parts of the United States. In fact, one study found prevalence rates to be 1.4% in Florida and a much higher 9.7% in New Hampshire. (1) Much of the research also indicates younger people and women tend to be at higher risk for winter depressive episodes.

People who already struggle throughout the year with clinical depression or bipolar disorder may also experience worsening symptoms during specific seasons. For those with seasonal depression, the episodes of depression that occur in the fall/winter are significantly greater than those episodes that occur throughout the remainder of the calendar year. In any case, it’s important to pay attention to seasonal patterns in your mood so that you can prepare and seek appropriate treatment and support as needed.

Common symptoms of seasonal depression
Seasonal depressive episodes generally set in during late fall or early winter. Some of the most common signs and symptoms include:

decreased energy, lethargy

increased sleep, difficulty waking

social withdrawal and loss of interest in activities previously enjoyed

increased appetite, unintended weight gain

persistent sadness, hopelessness

difficulty concentrating or focusing on tasks

(Though less common, some people experience spring/summer depressive episodes and those symptoms can look a little different, more often encompassing sleeplessness, irritability, decreased appetite and weight loss, etc.)

How might seasonal depression affect people with eating disorders?
A depressive episode can impact eating patterns and thus, impact eating disorder recovery efforts. Individuals suffering from seasonal depression often report increased appetite. Specific studies have indicated that individuals with SAD tend to experience more cravings for foods that are higher in carbohydrates and rich in starch and report increased consumption of carbohydrates when depressed, anxious or lonely. (2) Combined with decreased energy and declining mood, these cravings can place one at higher risk for binge eating behaviors.

Other research has shown a seasonal component to depression especially for those individuals suffering from Bulimia Nervosa. (3) The research revealed that patients with Bulimia Nervosa tended to experience seasonal patterns of mood and appetite similar to those described by many with SAD. (4) Some research has further speculated with regard to a possible genetic link between eating disorders and susceptibility to changes in mood related to the season. (5)

Treatment Options for Individuals affected by seasonal depression
So what can you do when the light outside your window has turned to darkness and, perhaps, this has added fuel to the eating disorder fire as well? The good news is that there are many different treatment approaches that are helpful to those suffering from seasonal depression.

Light therapy or Phototherapy is a commonly prescribed treatment for individuals suffering from seasonal depression. In light therapy individuals sit in front of a “light box” for approximately thirty minutes daily or per their doctor’s recommendation. Research has shown that light therapy can relieve the symptoms of seasonal depression in as many as 70% of cases. (6)

Anti-depressant medications can also be helpful in treating winter depression and have been shown to improve mood, energy and sleep patterns. One of the ways in which these medications work is by increasing serotonin levels in the brain.

Behavioral interventions in your daily life can also be helpful in reducing symptoms of seasonal depression. Consider trying to incorporate some or all of these:

Engage in activities with friends and family each day to ward off feelings of lonliness or isolation.

Make a point to get outside in the sunlight for at least a portion of the day if possible. Schedule a walk with your colleague during break or sit outside instead of inside while you do your daily perusing of Facebook, however…

Be mindful about whether online social networks make you feel worse instead of better OR if they take up large amounts of time that could be better spent connecting with people in person (see #1 above).

Plan to get plenty of sleep on a consistent schedule; do your best to go to bed and wake up at the same times each day, and aim for 7-8 hours of sleep/day.

Avoid the use of alcohol or other substances which can worsen depressive symptoms, complicate eating disorder symptoms and disrupt sleep.

Focus on the highlights of the changing season.
If you struggle with seasonal depression, a long autumn and the approaching winter can feel daunting. Holiday stress, can make things even more difficult for individuals who are triggered by tense family dynamics, elaborate meals and social gatherings. This year, Instead of focusing on the doldrums of the season or annual stressors, consider looking for positive seasonal activities in which to get involved. Now is the perfect time to go to a holiday parade, paint a room in your house a new color, volunteer for a new cause, plan a weekend getaway, attend a recovery event, build a snowman or read a winter-themed book. It could also be a great opportunity to finish your summer vacation scrapbook or try a new activity like snow tubing or ice skating. You can even practice guided imagery or meditation – just because there is snow outside it doesn’t mean you can’t imagine yourself relaxing on a warm beach.

Try not wish away the winter season. Each season comes with its own set of challenges for individuals with eating disorders – just think of the onslaught of diet pressures throughout spring or the bathing suit saga of summer. So the key is not to just “get through” each season (there will be a new set of stressors on the next calendar page after all) but to learn to live mindfully in each season and find ways you can enjoy what it has to offer.

Above all else remember to ask for help when you need it. Talk to your treatment providers about your seasonal mood changes and they can help to devise an individualized treatment plan that works for you. If you are seeing a Registered Dietitian now is the time to talk with them about the food cravings you might be experiencing and devise an approach to cope and integrate more variety into your meal plan. Remember to open up and involve your support system– let your friends or family be a part of the process by sharing with them what you are going through. With help and support, you’ll be celebrating the Vernal Equinox in no time and reflecting on a well-spent, memorable winter.

For questions about treatment for co-occurring depression and eating disorders, please visit our website at www.eatingdisorder.org

Earlier this week, Dr. Drew Pinsky made some misleading comments about “exercise bulimia” in a video featured on CNN iReport. The comments sparked concern because of the implications they could have for individuals who are struggling with excessive exercise and for those who may be at-risk. Dr. Harry Brandt, CED Director, was motivated to reach out to Dr. Drew in hopes of opening a public conversation that will shed light on eating disorders and spread accurate information regarding just how serious excessive exercise can be. The letter is published below:

I would be most appreciative if you would consider following up on this issue publicly to raise awareness about the seriousness of bulimia nervosa, with particular attention to those individuals that use compulsive exercise as their means of purging.